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How To Report Anesthesia Time To Ensure Accurate Anesthesia Pay
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Calculating time units for anesthesia services can get tricky for even the most experienced coders. To help you avoid denials and reimbursement loss, let’s look at five practical scenarios that address how to correctly calculate time units for your anesthesia claims and reports.
What are the minimum documentation requirements to be compliant with reporting anesthesia prep time? My anesthesia provider only performed a review of the patient’s chart. Can that be considered compliant for documentation purposes, or should I consider other elements besides a review of the chart?
Per CMS guidelines, anesthesia time starts when the anesthesiologist begins to prepare the patient for the anesthesia in the operating room and stops when he or she transfers the care to another caregiver. Usually, anesthesia stop time is within 10-15 minutes of the surgical stop time. If it takes longer, you need to mention the reason in the record.
The anesthesia care during the procedure covers the administration of fluids/blood and normal monitoring services such as ECG, blood pressure, temperature, etc.
Based on these guidelines, performing a chart review is not enough to report the service. This time is not separately reported, as it’s included in the base value for the service performed.
Our anesthesia practice does not follow the industry standard for rounding up time for our units after 7 minutes. What is the best and most practical advice for rounding up time as opposed to billing exact minutes?
Answer: Since the ANSI 5010 claim form was implemented, rounding up anesthesia time to the next unit may not be the correct practice. The ANSI form requires that you bill anesthesia time per minute and not by units. It’s important that all electronic HIPAA-standard transactions are compliant with the ANSI Version 5010 version.
What is the official stop time for an epidural used in labor and delivery? Should we stop counting at the time of delivery or when the catheter is removed?
Answer: Anesthesia time ends when the provider removes the patient’s catheter. Policies vary, though, from one payer or hospital to another, and there isn’t a definitive answer to this question, considering the variables that may be involved. For instance, all locations do not provide the same type of obstetric services. Moreover, the payer might follow a policy that defines ending time for labor epidural. Texas Medicaid, for example, requires providers to refer to the definition of time in the 'Anesthesia Guidelines-Time Reporting' section of the CPT® manual. Colorado Medicaid, on the other hand, suggests that you report as per "direct patient contact epidural time." Irrespective of which stop time guidance you use, the code most frequently used for labor and delivery epidurals is 01967.
Our physician performed anesthesia (started at 9.00 a.m. and ended at 10.15 a.m.) during an exploration of the pericardial sac – without using the pump oxygenator. The patient has been categorized as P3 due to severe hypertension and diabetes mellitus. How do we report this?
Answer: Start by calculating your time units and add those to the base units for the anesthesia code. The correct code that you’ll use for your scenario is 00560, with 15 base units. Anesthesia time lasted 75 minutes (5 time units). While reporting P3, add more units to the claim due to the increased risk of putting the patient under anesthesia.
5 time units + 15 procedure base units + 1 unit for P3 modifier = 21 units of billable anesthesia. Multiply 21 units with your practice conversion factor to get the final charge.
What is the correct formula to ensure our practice’s Medicare reimbursement is accurate – Is it time units + base units multiplied by conversion factor?
Answer: Yes. Time units for Medicare are calculated in tenths of a unit. If your total anesthesia time was 72 minutes, then your time units would be 72 minutes/15 minutes = 4.8 units (and not 5 units). Nevertheless, you need to report total minutes on the claim form and not units.
However, if your anesthesiologist provided medical direction or supervision, the reimbursement will vary. Refer to Chapter 12, Section 50 of the Medicare Claims Processing Manual.
Other payers may follow different requirements and may calculate the units differently. Still have questions? Anesthesia Coding Alert can guide you through the complexities of time unit calculation and tricky anesthesia coding and billing guidelines.
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